Depression is a disease
By Dr Brighton Chireka
A LOT of you have been emailing asking about depression and what can be done about it. This article will address your concerns and I hope that when you finished reading it, you will be much wiser. Depression is more than simply being fed up or feeling unhappy for a few days. It is not just kufingisisa (thinking too much). In life we all go through spells of feeling down for a few days but when it is depression it lasts for several weeks or months.
Depression is not trivial; it is a real illness with real symptoms. It’s not a sign of weakness or something you can “snap out of” by “pulling yourself together”. It’s a health problem that affects our mood, thoughts, feelings, behaviour and our general health. It can make people focus mainly on failures and disappointments of their lives and negative side of situations. It can make people feel hopeless and powerless resulting in them not seeing a way out or light at the end of a tunnel. The good news is that with the right treatment and support, most people can make a full recovery and I hope reading this article is a first step to recovery.
There are different types of depression and some conditions where depression may be one of the symptoms. These include: Postnatal depression, whereby women develop depression after having a baby. Postnatal depression is treated in similar ways to other forms of depression, with talking therapies and antidepressant medicines. Bipolar disorder is also known as “manic depression”. It’s where there are spells of depression and excessively high mood (mania). The depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour such as gambling, going on spending sprees and having unsafe sex. Seasonal affective disorder (SAD), also known as “winter depression” is a type of depression that has a seasonal pattern usually related to winter.
Depression in Zimbabwe
Depression in Zimbabwe is common, especially in women, and causes considerable disability. Some studies have shown that among adults, 25% of people attending primary care and 33% attending traditional healer attenders had depression. Research by Patel, V et al (2001) showed that 16% of mothers and women living in the community suffered from depression. Depressed people visit health services frequently and also consult private doctors and traditional medical practitioners. The latter is associated with high financial costs of health care.
As with many things in life, there is wisdom in recognizing what we can do for ourselves and where we need help from others. Many people wait a long time before seeking help for depression, but it is best not to delay. The sooner you see a doctor, the sooner you can be on the way to recovery. Depression affects people in different ways and can cause a wide variety of symptoms. You need to see a doctor if you have any of the following symptoms for more than two weeks: Feeling constantly tired, failing to concentrate, sleeping badly, having no appetite or sex drive, and complaining of various aches and pains. Also feelings of sadness and hopelessness, losing interest in the things you used to enjoy and feeling very tearful.
Please do not ignore it if you feel suicidal and that life is no longer worth living. Thoughts of suicide must not be ignored as no one is immune to suicide. It is sad that we have lost Zimbabweans in the UK by suicide and the death of Edmore Ngwenya in Manchester in 2009 comes to my mind and I remember writing an article about it.
Suicide is a major health issue and suicide prevention is a UK government priority. In the UK there are nearly 6,000 suicide deaths per year, and nearly 500 further suicides in Ireland. Approximately three-quarters of these occur in men, in whom suicide is the most frequent cause of death among those under 35 years of age. The most common method of suicide is hanging, followed by self-poisoning. Depression is the most common disorder, found in at least 60% of cases hence the need to prevent and treat depression effectively.
Clinicians working in a range of settings will encounter depressed people who may be at risk. For example, approximately 50% of those who take their own lives will have seen a general practitioner in the three months before death; 40% in the month beforehand; and around 20% in the week before death. Primary care staff are therefore in a particularly important position in the detection and management of those at risk of suicide. Also, approximately a quarter will have been in contact with mental health services in the year before death. All medical professionals need to be vigilant for people who may be at risk of suicide. It is also important to recognise that the effects of suicide on families can be devastating and can also have a profound effect on professionals involved in their care.
There is no defined known cause of depression. Sometimes there is a trigger for depression. Life-changing events, such as bereavement, divorce, violence, infertility, losing your job or unwanted pregnancy – even having a baby, can bring it on. It is quite common and affects about 1 in 10 of us at some point. It affects men and women, young and old, black or white people. It also runs in the family, meaning that if someone in your family has suffered from depression in the past, such as a parent or sister or brother, then it’s more likely you will too.
Treatment for depression involves either medication or talking treatments, or, usually, a combination of the two. The kind of treatment that your doctor recommends will be based on the type of depression you have. Many people with depression benefit from making lifestyle changes such as getting more exercise, cutting down on alcohol and eating more healthily. Self-help measures such as reading a self-help book or joining a support group are also worthwhile.
It may be tempting to smoke or drink to make you feel better. Cigarettes and booze may seem to help at first, but they make things worse in the long run. Be extra cautious with cannabis. You might see it as harmless, but research has revealed a strong link between cannabis use and mental illness, including depression. The evidence shows that if you smoke cannabis you make your depression symptoms worse, feel more tired and uninterested in things, are more likely to have depression that relapses earlier and more frequently and you will not have as good a response to antidepressant medicines. And don’t be tempted to drown your sorrows with a drink. Alcohol is categorised as a “strong depressant” and actually makes depression worse.
There are some key steps you can take to lift your mood and help your recovery from depression. It is important to take your medication as prescribed, even if you start to feel better. If you stop your medication too soon, you could have a relapse of your depression. Exercise and a healthy diet can make a tremendous difference to how quickly you recover from depression. And they will both improve your general health, too. Research suggests that exercise can be as effective as antidepressants at reducing depression symptoms. Being physically active lifts your mood, reduces stress and anxiety, boosts the release of endorphins (your body’s feel-good chemicals) and improves your self-esteem. It also helps your mood to have a healthy diet. In fact, eating healthily seems to be just as important for maintaining your mental health as it is for preventing physical health problems.
Sharing a problem with someone else or with a group can give you support and an insight into your own depression. Research shows that talking can help people recover from depression and cope better with stress. You may not feel comfortable about discussing your mental health and sharing your distress with others. If so, writing about how you feel or expressing your emotions through poetry or art are other ways to help improve your mood.
Be careful on how you use social media. Facebook is not a shoulder to cry on because that shoulder is not real, it’s artificial. There is no confidentiality or respect of your privacy and there are people out there who will use your problem to further their own personal interests. With social media you will come out bruised and with dirt in your hands. The so-called friends on Facebook will “click like” even if you are in tears or crying for help.
In Zimbabwe there are initiatives that are helping a lot of people with depression. We have the The Friendship Bench Project. This is a lay worker-led mental health intervention that has been implemented within a community in Harare. The Friendship Bench is not only a very special physical place for seeking advice and support for the people of Mbare township but it is also the name of a whole collaborative project providing mental health services to one of the city’s most impoverished regions.
The Friendship Bench project brings mental health doctors such as Dr Dixon Chibanda (who is the principal investigator on the Friendship bench project) and Dr Melanie Abas (who is a clinical senior lecturer in global mental health at the Institute of Psychiatry, King’s College London and an honorary lecturer in psychiatry at the University of Zimbabwe College of Health Sciences) and educators as well as students from London and Zimbabwe together to provide support and supervision for a network of lay health workers. Lay health workers are being trained to use basic “talking intervention techniques” to increase patients’ coping skills and resilience as well as medication adherence.
I am involved with Zimbabwe Health Training Support (ZHTS) which is a voluntary UK based diaspora organisation, set up in April 2006 by a group of health professional concerned about health training in Zimbabwe. The group supports health professional training and continuing education in Zimbabwe and is a partner of the Friendship bench project which is doing a lot of good work to help people suffering from depression.
Some of the Zimbabwean diaspora feel isolated and hopeless because they have no one locally to talk to. They spend most of their time at work and phone people in Zimbabwe who at times make the situation worse by presenting their own problems instead of being an ear to the poor Diaspora. Some of these people end up in hospital suffering from depression. This suffering in silence can be ended if people become aware that we are now a big community. We now have Zimbabwean-based churches for those who are religious. I do attend church in London every week and I feel at home. It makes me forget all my problems and I encourage all of you to find a church near you to attend. You are always welcome in the house of God.
We the Zimbabwean Diaspora are also losing friends and relatives in Zimbabwe and many of us cannot go back home to pay our last respects. It is difficult to grieve alone and come to terms with the loss when we are thousands of miles away. Local religious groups and friends will help us in the grieving process. Back home we used to care for our extended families, an uncle from rural areas would just turn up at your place in Harare unannounced and live with you for months or years. I know that things are now changing back home but my point is that we should help one another as a community. A problem shared is a problem solved. There are people out there who are prepared to lend an ear or a shoulder to cry on. I encourage you to find an organisation or a religious group and get involved. We should not allow ourselves to suffer in silence.
There is a need for the public to present early to health professionals and there is also a greater need on the part of doctors to address the cause or triggers of depression and stop treating symptoms only (giving vitamins for tiredness or “sleeping pills” for lack of sleep). There is no excuse for not getting help wherever you are. Help is around you and also from your doctor.
You may want to read about suicide
This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: firstname.lastname@example.org and can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.